Request for CHAPS Transfer

To the Bank

Please forward the following CHAPS payment to HM Revenue and Customs. Please ensure that all of the details marked with an asterisk (\*) are submitted with the payment, in the stipulated fields (and lines where shown), exactly as they appear in the box.

| For Bank Use Only | Swift Field | |-------------------|-------------| | Date Payment To Be Made (ddmmyyyy) | 32A\* |

**CUSTOMER DETAILS**

| Account Name To be Debited | 50K Line 1\* | |-----------------------------|-------------| | Customer Address | 50K Lines\* 2-5 | | Account Number To Be Debited | | | Sort Code (Account Holding Branch) | | | Currency Code (GBP or Eur) | 32A\* | | Amount | 32\* |

Amount in words

**BENEFICIARY DETAILS**

| Sort Code (Beneficiary Bank) | //SC08 32 10 | 57DK Line 1\* | |-----------------------------|-------------|-------------| | Bank Name | Citibank | 57D Lines\* 2-5 | | Account Number To Be Credited | 12001020 | 58D\* | | Beneficiary Name | HMRC Shipley | 58D |

**ADDITIONAL INFORMATION**

| Corporation Tax Reference (for example 1234005678A00101A) | 70 Line 1\* | |----------------------------------------------------------|-------------|

Please ensure that full details are forwarded to the Accounts Office 3 days before payment

SIGNATURE(S) ................................................................. DATE .................................

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